Gallstone ileus obstructing within an incarcerated lumbar hernia: an unusual presentation of a rare diagnosis

We describe an unusual case of a 74-year-old woman who presented with signs and symptoms of small-bowel obstruction and a clinically appreciable, irreducible, left-sided lumbar hernia associated with previous iliac crest bone graft harvesting. Palpation of the hernia demonstrated a small, firm mass...

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Bibliographic Details
Published in:BMJ case reports 2014-12, Vol.2014, p.bcr2014208213
Main Authors: Ziesmann, Markus Tyler, Alotaiby, Nouf, Abbasi, Thamer Al, Rezende-Neto, Joao B
Format: Article
Language:English
Subjects:
Abdomen
Aged
Defects
Female
Gallstones - complications
Gallstones - diagnostic imaging
Gallstones - surgery
Heart attacks
Hernias
Humans
Ileus - complications
Ileus - diagnostic imaging
Ileus - surgery
Intervertebral Disc Displacement - diagnostic imaging
Intervertebral Disc Displacement - physiopathology
Intervertebral Disc Displacement - surgery
Laparoscopy
Laparotomy - methods
Lumbar Vertebrae
Medical imaging
Mortality
Rare Diseases
Reminder of Important Clinical Lesson
Risk Assessment
Severity of Illness Index
Surgery
Tomography, X-Ray Computed - methods
Treatment Outcome
USA/Canada
White
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Summary:We describe an unusual case of a 74-year-old woman who presented with signs and symptoms of small-bowel obstruction and a clinically appreciable, irreducible, left-sided lumbar hernia associated with previous iliac crest bone graft harvesting. Palpation of the hernia demonstrated a small, firm mass within the loops of herniated bowel. CT scanning recognised an intraluminal gallstone at the transition point, establishing the diagnosis of gallstone ileus within an incarcerated lumbar hernia. The proposed explanatory mechanism is that of a gallstone migrating into an easily reducible hernia containing small bowel causing obstruction at the hernia neck by a ball-valve mechanism, resulting in proximal bowel dilation and thus hernia incarceration; it remains unclear when the stone entered the hernia, and whether it enlarged in situ or prior to entering the enteral tract. This is only the second reported instance in the literature of an intraluminal gallstone causing hernia incarceration.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2014-208213